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Celiac.com 05/08/2017 - Do non-celiacs who eat a gluten-free diet face a greater risk of developing coronary heart disease?
To shed some light on this question, a team of researchers recently set out to assess levels of long-term term gluten consumption in connection with the development of coronary heart disease. The research team included Benjamin Lebwohl, Yin Cao, instructor, Geng Zong, Frank B Hu, Peter H R Green, Alfred I Neugut, Eric B Rimm, Laura Sampson, Lauren W Dougherty, Edward Giovannucci, Walter C Willett, Qi Sun, and Andrew T Chan.
They are variously affiliated with the Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
For their prospective cohort study, the team looked at 64,714 women in the Nurses’ Health Study and 45,303 men in the Health Professionals Follow-up Study. None of the subjects had any history of coronary heart disease, and all completed a 131 item semiquantitative food frequency questionnaire in 1986 that was updated every four years through 2010.
The researchers estimated gluten consumption based on the results of the food frequency questionnaires. Their study looked for patients who developed coronary heart disease, specifically fatal or non-fatal myocardial infarction. The team’s study data covered 26 years of follow-up, totaling 2,273,931 person years, 2431 women and 4098 men developed coronary heart disease.
Participants in the lowest fifth of gluten intake had 352 incidences of coronary heart disease per 100,000 person years, while those in the highest fifth had a rate of 277 events per 100,000 person years. This equates to 75 fewer cases of coronary heart disease per 100,000 person years.
After adjusting for known risk factors, the researchers noted that patients in the highest fifth of estimated gluten intake had a multivariable hazard ratio for coronary heart disease of 0.95 (95% confidence interval 0.88 to 1.02; P for trend=0.29).
After further adjusting for intake of whole grains, and leaving the remaining variance of gluten corresponding to refined grains, the multivariate hazard ratio was 1.00 (0.92 to 1.09; P for trend=0.77).
In contrast, after additional adjustment for intake of refined grains (leaving the variance of gluten intake correlating with whole grain intake), estimated gluten consumption was associated with a lower risk of coronary heart disease (multivariate hazard ratio 0.85, 0.77 to 0.93; P for trend=0.002).
Long term dietary intake of gluten was not associated with risk of coronary heart disease. However, the researchers do stress the importance of dietary whole grains, and that their absence may increase the risk of cardiovascular disease. Because of this, the team discourages people without celiac disease, or some other medical reason, from adopting a gluten-free diet.
Source:
BMJ 2017;357:j1892 (Published 02 May 2017)

Celiac.com 05/16/2017 - A number of studies have indicated that kids with celiac disease face an increased risk for mood disorders, anxiety and behavioral disorders, ADHD, ASD, and intellectual disability. A new study by a team of researchers in Sweden puts it more precisely. They put the increased risk for psychiatric disorders in children with celiac disease at 1.4-fold over kids without celiac disease.
The research team assessed the risk of any type of childhood psychiatric disorders, including psychosis, mood, anxiety, and eating disorders, psychoactive substance misuse, behavioral disorder, ADHD, ASD, and intellectual disability, in children aged 18 and younger, along with their siblings. The researchers included Agnieszka Butwicka, MD, PhD, of the department of medical epidemiology and biostatistics, Karolinska Institute, Stockholm, Sweden, and colleagues.
For each of the 10,903 children with celiac disease, the research team randomly selected 100 non-celiacs from the general population. These control subjects were then matched by gender and year and country of birth. For each of the 12,710 siblings of celiac disease subjects, the research team randomly assigned 100 healthy control siblings from the general population. These were also matched by gender, year and country of birth of both siblings. Both sets of siblings were required to be free of celiac disease to age 19.
The researchers reviewed histological data on patients who showed villous atrophy in small intestine biopsy specimens between 1969 and 2008, and equated villous atrophy with celiac disease.
In the main cohort study, the researchers estimated the risk for any psychiatric disease, as well as specific psychiatric disorders (ie, mood, anxiety, eating, and behavioral disorders, as well as neuropsychiatric disorders such as attention deficit hyperactivity disorder (ADHD), autistic spectrum disorders (ASD), and intellectual disability) in children with celiac disease, compared with general population controls. They used sibling analyses to assess whether underlying familiar factors could account for the associations. As a comparing factor, they compared the risk for psychiatric disorders in the siblings against the risk in siblings of the general population.
The team conducted both univariate and multivariate analyses, adjusting for maternal/paternal age at the child's birth, maternal/paternal country of birth, level of education of highest-educated parent, and the child's gestational age, birthweight, Apgar score, and history of psychiatric disorders prior to recruitment.
During follow-up, 7.7% of children were diagnosed with a psychiatric disorder. A positive association was found in the first univariate analysis between celiac disease and any psychiatric disorder, which remained even after the researchers adjusted for maternal/paternal age at childbirth and country of birth, parental education level, and child's gestational age, birthweight, Apgar score, and previous history of psychiatric disorders.
The overall prevalence of psychiatric disease in the entire sample celiac disease patients was about 7% (95% CI, 6.4%-7.4%). That number remained steady in the 10 years after biopsy. However, once the researchers analyzed the findings by cohort, they found that rates of psychiatric disorders had actually increased 8-fold over that 10-year period.
The siblings of celiac disease patients showed no increased risk for any psychiatric disorder. The study showed that psychiatric disorders "may precede a diagnosis of celiac disease in children." The research team called this finding "important." They write that their study also offers "insight into psychiatric comorbidities in childhood celiac disease over time." The study showed that children with celiac disease definitely faced an elevated risk for specific psychiatric disorders, including mood disorders (HR, 1.2; 95% CI, 1.0-1.4), anxiety disorders (HR, 1.2; 95% CI, 1.0-1.4), eating disorders (HR, 1.4; 95% CI, 1.1- 1.8), behavioral disorders (HR, 1.4; 95% CI, 1.2-1.6), ADHD (HR, 1.2; 95% CI, 1.0-1.4), ASD (HR, 1.3; 95% CI, 1.1-1.7), and intellectual disability (HR, 1.7; 95% CI, 1.4-2.1).
Although the study showed that patients with celiac disease are more likely to have prior psychiatric disorders (OR, 1.8; 95% CI, 1.5-2.1; P
The team notes that they have yet to determine "the mechanisms underlying the association between celiac disease and psychiatric orders." The fact that the siblings of celiac disease patients showed no increased risk of psychiatric disorders indicates that these may be an "effect of celiac disease per se rather than common genetic or within-family environmental factors," the researchers add.
The researchers conclude that their study "underscores the importance of both mental health surveillance in children with celiac disease and a medical workup in children with psychiatric symptoms."
This study offers yet another piece in the complex puzzle that is celiac disease. It emphasizes the need for doctors and parents to remain on the lookout for potential psychiatric issues when dealing with children who have celiac disease.
Source:
Psychiatry Advisor

Celiac.com 02/09/2009 - An extensive recent survey of the Swedish cancer registry reveals that people with celiac disease face a 5-fold increased risk of developing non-Hodgkin lymphoma, but that the risk has decreased by more than 50% over the last 40 years.
Researchers at the National Cancer Institute (NCI) in Bethesda, Maryland, and Sweden's Karolinska Institute recently undertook a review of more than 60,000 lymphoma cases diagnosed in Sweden between 1965 and 2004. They matched those cases to individual lymphoma-free controls with similar characteristics.
Dr. Ying Gao of the NCI and colleagues found 37,869 cases of non-Hodgkin's lymphoma, 8,323 cases of Hodgkin's lymphoma, 13,842 cases of chronic lymphocytic leukemia.
The researchers also enrolled 236,408 matched controls and 613,961 first-degree relatives. The team used hospital discharge information to identify people with a history of celiac disease.
The data revealed that people with a hospital discharge diagnosis of celiac disease faced a 5.35-fold increased risk of developing non-Hodgkin's lymphoma. The data also showed that risk of Hodgkin's lymphoma was mildly elevated, and thst celiac patients showed no elevated risk of developing chronic lymphocytic leukemia.
The data showed that from 1975-1984, patients with celiac disease faced a 13.2-fold greater risk of non-Hodgkin's lymphoma; from 1985-1994, that level fell to a 7.90-fold increased risk, and from 1995-2004 that risk fell again to 3.84-fold increased risk. Siblings of those affected with celiac disease also faced a 2.03-fold greater risk of non-Hodgkin's lymphoma.
At present, doctors do not clearly understand the causal link between the two. Earlier studies have indicated that the inflammation common to celiac disease leads drives lymphoma development.
According to the research team, the study carries two basic messages:
The first is that earlier detection of celiac disease is helping to lower the risk of developing lymphoma over time, so today, fewer people are detected in the late stages, when the risk of lymphoma is much greater.
The second message is that people with a family history of celiac disease have a greater chance of developing lymphoma. This family connection was shown to be separate from the personal celiac disease history of the individual.
Together, these revelations suggest that shared mechanisms might contribute to both celiac disease and lymphoma.
The full report appears in the medical journal Gastroenterology, January 2009.

Celiac.com 03/01/2010 - Common autoimmune disorders often coexist in the same subjects, and to cluster in families. A research team recently set out to quantify the risk of diagnosis of coexisting autoimmune diseases in more than 3000 index cases with clinically proven Graves' disease or Hashimoto's thyroiditis.
The research team included Kristien Boelaert, PhD, Paul R. Newbya, Matthew J. Simmonds, PhD, Roger L. Holder, Jacqueline D. Carr-Smith, Joanne M. Heward, PhD, Nilusha Manjia, Amit Allahabadia, MD, Mary Armitage, DM, Krishna V. Chatterjee, PhD, John H. Lazarus, MD, Simon H. Pearce, PhD, Bijay Vaidya, PhD, Stephen C. Gough, PhD, and Jayne A. Franklyn, PhD.
To establish the prevalence of coexisting autoimmune disorders, the team conducted a cross-sectional multi-center study of 3286 Caucasian subjects from UK hospital thyroid clinics. 2791 of those had Graves' disease, 495 had Hashimoto's thyroiditis.
The team used a comprehensive questionnaire to obtain complete personal and parental history for each subject, including information on common autoimmune disorders, and parental history of hyperthyroidism or hypothyroidism.
The frequency of other autoimmune disorders was 9.67% for patients with Graves' disease and 14.3% for those with Hashimoto's thyroiditis index cases (P=.005).
Rheumatoid arthritis was the most common coexisting autoimmune disorder, striking 3.15% of patients with Graves' disease, and 4.24% of Hashimoto's thyroiditis cases.
However, both conditions carried substantially higher relative risks for nearly all other autoimmune diseases (>10 for pernicious anemia, systemic lupus erythematosus, Addison's disease, celiac disease, and vitiligo).
Cases of Graves' disease showed relative “clustering” among index subjects with parental hyperthyroidism, while cases of Hashimoto's thyroiditis showed relative “clustering” among index subjects with parental hypothyroidism.
Relative risks for most other coexisting autoimmune disorders were markedly increased among parents of index cases.
This study is one of the largest so far to quantify the risk of diagnosis of coexisting autoimmune diseases among more than 3000 index cases with clinically proven Graves' disease or Hashimoto's thyroiditis.
These results emphasize the the importance of screening for other autoimmune diagnoses when patients with autoimmune thyroid disease show new or nonspecific symptoms.
Source: Am. J. Med. Volume 123, Issue 2, Pages 183.e1-183.e9 (February 2010)

Celiac.com 10/10/2008 - A team of Finnish researchers announced that they have found high rates of undetected celiac disease in elderly populations. They have also noted that a significant number of those older people diagnosed with celiac disease showed only minor symptoms. The study team was made up of doctors A. Vilppula, P. Collin, M. M¨aki, R. Valve, M. Luostarinen, I. Krekel¨a, H. Patrikainen, K. Kaukinen, and L. Luostarinen.
Even with a wealth of new information on celiac disease from numerous recent studies, along with better testing methods, we still don’t know very much about rates of celiac disease in older people. Motivated by that fact, the team recently set out to study the prevalence of celiac disease in elderly populations.
In theory, celiac disease should occur in the elderly at rates similar to, or lower than, those of the general population. Since current research indicates that about 1 person in a hundred has celiac disease, it seems logical to figure that rates of celiac disease among the elderly would be the same or even lower than rates for the general population.
The researchers figured that clinically silent or undiagnosed celiac disease would be rare in elderly populations, as they would be likely to develop obvious symptoms. But the team was surprised to find that rates of celiac disease among the elderly are more than double those of the general population. They looked at 2,815 individuals between the ages of 52–74. They took blood samples from everyone and isolated people who showed signs of clinical celiac disease. They then screened the samples for IgA tissue transglutaminase antibodies. Subjects with positive antibody tests were given a small bowel biopsy. The doctors found celiac disease in 60 individuals, 25 (0.89%) through positive blood tests, and 35 (1.24%) through biopsy, for a total prevalence of in elderly subjects of 2.13% with 95% confidence intervals (1.60–2.67%). Of the screen-detected cases, only 15 had symptoms, and those were mostly mild. Driving home the dangers of late diagnosis, two out of the 60 had small bowel T-cell lymphoma and two had gastric cancer.
Altogether, celiac disease was diagnosed through biopsy, and by blood test without a post-gluten-free diet follow-up test at a rate of 2.45% (1.88–3.02%).
This study shows that celiac disease is far more prevalent in elderly people than in the general population. To better detect and treat celiac disease in elderly populations, the doctors are encouraging the use of active case finding using blood tests, since undetected celiac disease can lead to serious complications and even early death.
2008 Editrice Gastroenterologica Italiana S.r.l.

Celiac.com 05/08/2007 - A recent study published in the journal Digestive Diseases and Sciences indicates that lesser degrees of villous atrophy correspond to seronegative celiac disease. The study was conducted by researchers J.A. Abrams, B. Diamond, H. Rotterdam, and P.H. Green, of the Department of Medicine, Columbia University College of Physicians and Surgeons in New York City. The research team set out to assess the effectiveness of various serologic tests used to diagnose celiac disease in patients with differing degrees of villous atrophy. The team evaluated 115 adult patients with biopsy-proven celiac disease. All participants met strict criteria, including serologic testing at the time of diagnosis and response to a gluten-free diet, 71% of participants showed total villous atrophy and 29% showed partial villous atrophy. Of those with total villous atrophy, 77% tested positive for endomysial antibody, compared to 33% with partial villous atrophy (P < 0.001). No difference in sensitivity was found between those who classical presentation of celiac disease versus those with silent presentation. Also, patients who were endomysial positive and patients who were endomysial negative showed no difference with respect to age at diagnosis, duration of symptoms, mode of presentation, or family history of celiac disease. Endomysial antibody positivity correlated not with the mode of presentation of celiac disease, but rather, with more severe villous atrophy. Lastly, the study showed that, in clinical practice, serologic tests lack the sensitivity reported in the literature. Digestive Diseases and Sciences, 2004 Apr; 49(4):546-50. health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.